In this issue we introduce a new article type – the outbreak investigation report – with our theme Outbreak investigations in the Western Pacific Region. This new article type allows for concise reports on outbreak investigations and expands the role of the Western Pacific Surveillance and Response Journal (WPSAR) as a regional information-sharing platform, as per the Asia Pacific Strategy for Emerging Diseases (APSED 2010) in line with the International Health Regulation (2005). Timely sharing of outbreak investigations may be useful in informing public health action across the Region.

During the overlap period between response and recovery activities, the authors were all working in the health sector at the national level supporting coordination and strategic planning with government and partners and at the field level implementing response activities and revisiting the medium- and long-term programming approach to recovery. It is from this perspective, combined with data from existing documents such as plans, reports and policies, that we highlight the need to define a period of transition from response to recovery of the health sector as it may have important implications on the health system functioning as a whole.

We established the Western Pacific Surveillance and Response Journal (WPSAR) in 2010 to increase the dissemination of data from surveillance systems in the Asia Pacific region as part of the Asia Pacific Strategy for Emerging Diseases.¹ WPSAR was to provide a platform for people working in surveillance and response in the Western Pacific Region to share scientific and operational findings and publish a broad range of articles not limited to conventional research articles.

In mid-2014, four years after the first issue of WPSAR, an online survey of WPSAR subscribers was conducted to assess the impact, network and visibility of WPSAR in the region to determine if these objectives had been met. Based on a similar survey undertaken by Eurosurveillance in 2011,² we sought to understand the WPSAR audience more comprehensively, how the journal is used and readers’ expectations. The WPSAR readership survey link was e-mailed to the 514 registered subscribers, and 25% responded.

Male obesity is associated with subfertility and increased disease risk of offspring. It is unknown if effects can be reversed through pharmacological interventions. Five- to 6-week-old C57BL6 male mice were fed control diet (n = 10, CD) or high-fat diet (n = 20, HFD) for 16 weeks. Animals fed with a HFD were then allocated to continuation of HFD (n = 8) or HFD with metformin 28 mg kg

In this editorial, the Editorial Team summarizes WPSAR's efforts to support and promote field epidemiology in the Western Pacific Region.

In this editorial, the Editorial Team reviews WPSAR journal's achievements over its 14 volumes so far, including the assignment of its first impact factor, and announces an expanded journal scope.

Problem: One month after the initial case of coronavirus disease 2019 (COVID-19) in Tasmania, an island state of Australia, two health-care workers (HCWs) from a single regional hospital were notified to public health authorities following positive tests for SARS-CoV-2 nucleic acid. These were the first recognized cases in an outbreak that overwhelmed the hospital’s ability to function. Context: The outbreak originated from two index cases. Both had returned to Tasmania following travel on a cruise ship and required hospital admission for management of COVID-19. A total of 138 cases were subsequently linked to this outbreak: 81 HCWs (most being nurses) and 23 patients across three hospitals, one resident of an aged-care facility and 33 close contacts. Action: The outbreak was controlled through the identification and isolation of cases, identification and quarantining of close contacts and their household members, closure of the affected facilities and community-level restrictions to reduce social mixing in the affected region. Lessons learnt: Factors that were likely to have contributed to ongoing transmission in this setting included workplace practices that prevented adequate physical distancing, attending work while symptomatic, challenges in rapidly identifying contacts, mobility of staff and patients between facilities, and challenges in the implementation of infection control practices. Discussion Many commonly accepted hospital practices before the COVID-19 pandemic amplified the outbreak. The lessons learnt from this investigation changed work practices for HCWs and led to wider public health interventions in the management of potential primary and secondary contacts.

Objective: We undertook an integrated analysis of genomic and epidemiological data to investigate a large healthcare-associated COVID-19 outbreak and to better understand the epidemiology of all COVID-19 cases in Tasmania, Australia. Methods: Epidemiological data collected on COVID-19 cases notified in Tasmania between 2 March and 15 May 2020, and positive SARS-CoV-2 samples or extracted RNA from those cases, were included. Sequencing was conducted by tiled amplicon PCR using ARTIC v1 or v3 primers and Illumina sequencing. Consensus sequences were generated, sequences were aligned to a reference sequence, and phylogenetic analysis performed. Genomic clusters were determined and integrated with epidemiologic data to assess any additional insights. Results: All COVID-19 cases notified in Tasmania during the study period (n=231) and 266 SARS-CoV-2 positive samples, representing 217/231 (94%) of notified cases, were included in the study; 182/217 (84%) were clustered, 21/217 (10%) were unique, 12/217 (6%) could not be sequenced. Genomics confirmed the presence of seven epidemiological clusters, clarified transmission networks where epidemiology was unclear and additionally identified another genomic cluster which had not been identified by epidemiology alone. Discussion